Site Search Navigation

Site Navigation

Site Mobile Navigation

Exercise May Ease Depression in Heart Failure Patients

By Anahad O'Connor July 31, 2012 4:47 pmJuly 31, 2012 4:47 pm

Photo

For those with heart failure, exercise may help ease depression.Credit Getty Images

Heart failure can take a heavy psychological toll, with many patients developing symptoms of depression. But a new study suggests that an exercise plan can ease the melancholy, creating improvements in mood that are comparable to the effects seen with medication.

For roughly a year, researchers followed more than 2,000 people treated for congestive heart failure at 82 medical centers in the United States, France and Canada. Those who were assigned to a moderate aerobic exercise program — about 90 to 120 minutes a week — saw greater reductions in symptoms of depression than those who were not enrolled in such a program.

“I think this shows that for patients who have heart failure, exercise is certainly an excellent treatment,” said Dr. James A. Blumenthal, a professor of medical psychology at Duke University Medical Center and the lead author of the study, which was published in The Journal of the American Medical Association. “It’s something that most patients can engage in. It results in improved cardiorespiratory fitness, they have more stamina, and now we see that not only do they derive these physical benefits, but they also derive psychological benefits as well.”

An estimated five million Americans are living with heart failure, with more than half a million new cases diagnosed each year. Patients often experience a drastic decline in their physical abilities, and with it a blow to their mental health. Up to 75 percent of patients develop some symptoms of depression, with about 40 percent suffering from full-blown clinical depression, which can worsen their overall prognosis.

Building on a growing body of research suggesting that aerobic exercise can elevate mood surprisingly well in people who have depression, Dr. Blumenthal and his colleagues set out to determine whether regular activity might have similar benefits in depressed heart failure patients. They began by assessing their subjects, whose average age was about 60, with a standard questionnaire called the Beck Depression Inventory II that rates depressive symptoms on a scale from 0 to 59. Higher scores indicate greater severity of depression, with a score of 14 or more generally considered to represent clinically significant depression.

At the beginning of the study, the median score of the participants was about 8, though about a third had a score of 14 or more.

The researchers then randomly assigned patients to one of two groups. Those in the first group completed three supervised exercise sessions a week for three months, typically at a cardiac rehab center, followed by 120 minutes a week of home exercise for another nine months. The patients primarily used treadmills and stationary bikes.

Those in the second group, meanwhile, received what the researchers called “usual care.” They did not receive any formal exercise instructions, only traditional recommendations to get about 30 minutes of activity most days of the week, in line with American Heart Association guidelines. Like those in the exercise group, they were also given detailed educational materials with information on things like medication and sodium intake.

As the researchers checked in at regular intervals, they found that the depression scores in the exercise group were consistently lower than in the control group — by about a point, which was a modest reduction. Patients who reported greater adherence to the exercise program had the most significant reductions in depressive symptoms.

For those who made up the subset of patients with the most severe symptoms — a depression score of 14 or greater — the difference between the exercise group and the control group was greater, with a reduction of about two points. Dr. Blumenthal said this magnitude of difference was similar to what has been shown in studies that have compared antidepressant use with placebo.

At the start of the study, one of the questions for the research team was whether heart failure patients could even exercise without hazard, which is why the first three months of exercise were supervised.

“I think historically, physicians have been very cautious about recommending exercise for these patients because it wasn’t clear that it was safe or that they would even derive the same benefits that other people derive,” said Dr. Blumenthal.

But it’s now clear that they do benefit in terms of aerobic capacity, he said, and that a moderate exercise program can be safe.

As for why exercise would provide psychological benefits, Dr. Blumenthal said he could only speculate.

“When you have a debilitating condition like this, there’s a tendency to feel you don’t have a lot of control over your health,” he said. “But I think for a lot of patients in this study, they felt like they were doing something positive for themselves, and they had an enhanced sense of self confidence. They could do more, they increased their strength and stamina, and I think that really served to improve their moods.”